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however, chronic hyperglycemia is associated with persistently low VO 2 peak due to an impaired adaptive response to training

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Chronic elevated levels of insulin and proinflammatory cytokines could explain the negative regulation of cortisol secretion, where increased insulin causes a deficient cortisol response to hypoglycemia, as occurs in patients with ME/CFS assessed using the insulin-induced hypoglycemia test [54, 58, 253, 262, 263, 365]